DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR CARDIAC RISK ASSESSMENT BEFOREAORTIC-SURGERY

Purpose: This study evaluates dobutamine stress echocardiography (DSE) for perioperative cardiac risk assessment with elective aortic surger y. Methods: Dobutamine stress echocardiography was used to evaluate 81 patients before infrarenal aortic surgery. Patients were placed into three groups. Group I (n = 31) had normal DSEs. Group II (n = 25) had resting wall motion abnormalities without dobutamine-induced changes o f ischemia. Group III (n = 25) had evidence of dobutamine-induced isch emia. Patient analysis revealed that of 46 patients with clinical indi cators of coronary artery disease (CAD), only 23 had DSEs with inducib le ischemia. Two of 35 patients without clinical indicators of CAD had DSEs with inducible ischemia. Results: The 56 patients in groups I an d II underwent aortic reconstruction without cardiac complications or death. Of the 25 patients in group III, surgery was deferred in five ( two patients with claudication and three with aneurysms less than or e qual to 5 cm), and four underwent coronary artery bypass grafting. Out come after coronary artery bypass grafting included one death from str oke, one aneurysm rupture, and two uncomplicated aortic reconstruction s. The remaining 16 patients in group III underwent aortic surgery, wi th three postoperative myocardial infarctions (MI) and no deaths. Conc lusions: Using DSE for preoperative assessment of cardiac risk allowed us to operate on 74 of 81 patients being considered for elective aort ic reconstruction, with no operative deaths and a 4.1% rate of periope rative MI. Dobutamine stress echocardiography has the ability to ident ify patients with asymptomatic stress-induced ischemic myocardium and its increased risk for perioperative MI (p < 0,001). Equally important , for patients with clinical indicators of CAD but without DSE-inducib le ischemia, no further cardiac evaluation is necessary.